Management of Middle Hepatic Vein Injury during Laparoscopic Cholecystectomy: A Case Report
23 November 2018
22 March 2019
09 March 2020 (online)
Background Cholecystectomy continues to be the first choice for the treatment of symptomatic cholelithiasis. Especially in patients with acute cholecystitis, a laparoscopic approach has become the standard treatment option. Intraoperative complications of laparoscopic cholecystectomy include: bile duct injury, organ damage, and bleeding due to vascular injury. Difficult hemorrhage during laparoscopic cholecystectomy occurs in 0.1 to 1.9% of all cases. Besides major vessel injuries, gallbladder bed vasculature is reported as a common injury site, mostly secondary to middle hepatic vein lesions.
Case Presentation We present a case report of a patient taken for a laparoscopic cholecystectomy. During the procedure, inadvertent middle hepatic vein injury occurs. Here we describe the management approach selected for this type of injury.
Discussion We recommend careful dissection during the final steps of a laparoscopic cholecystectomy. Following cystic duct and cystic artery ligation, surgeons often inappropriately relax through the last part of the dissection. During this final dissection, if care is not taken, small vascular structures can be missed and injured.
- 1 European Association for the Study of the Liver (EASL). Electronic address: firstname.lastname@example.org. EASL clinical practice guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol 2016; 65 (01) 146-181
- 2 Kimura Y, Takada T, Kawarada Y. , et al. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 2007; 14 (01) 15-26
- 3 Tazuma S, Unno M, Igarashi Y. , et al. Evidence-based clinical practice guidelines for cholelithiasis 2016. J Gastroenterol 2017; 52 (03) 276-300
- 4 Ball CG, MacLean AR, Kirkpatrick AW. , et al. Hepatic vein injury during laparoscopic cholecystectomy: the unappreciated proximity of the middle hepatic vein to the gallbladder bed. J Gastrointest Surg 2006; 10 (08) 1151-1155
- 5 Deziel DJ, Millikan KW, Economou SG, Doolas A, Ko ST, Airan MC. Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg 1993; 165 (01) 9-14
- 6 Misawa T, Koike M, Suzuki K. , et al. Ultrasonographic assessment of the risk of injury to branches of the middle hepatic vein during laparoscopic cholecystectomy. Am J Surg 1999; 178 (05) 418-421
- 7 Kaushik R. Bleeding complications in laparoscopic cholecystectomy: Incidence, mechanisms, prevention and management. J Minim Access Surg 2010; 6 (03) 59-65
- 8 Levi Sandri GB, Eugeni E, Bufo A, Dominici E. Unexpected bleeding during laparoscopic cholecystectomy: a hepatic vein injury. Surg Radiol Anat 2017; 39 (09) 1061-1062